Community health assessment
Presented by:
Dr: Amira Yahia
Learning outcomes
By the end of this session the students will be able to:
1-define some terms related to community
2-identify the concept of community
3-discuss the components of community
4-describe the function of community
5-identify the factors that affect the dynamics of
community
6-explain dimension of community as clients
7-discuss community health assessment
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Definition
Some authors describe community as:
A group determined by
 geographic boundaries & / or
 common value and interest,
 Its members know and interact with one another,
 It functions within a particular social structure and
exhibits ,
 creates norms, values and social relations. (WHO1974)
“Community”

Communities of Place: Defined by distinct
boundaries and bound by a common political,
economic and social system.

Communities of Interest: A group of individuals that
share common interests, goals, or knowledge about
something.
Concept of community includes three
dimensions:
people, place, and function.

People are the community residents.

Place refers to both geographic and time
dimensions

Function refers to the aims and activities of
the community
Components of community:
1-People: they are the most important
resources
2-Goals &Needs: refers to goals and needs of
people in the community ,which follow
mallow's hierarchical order of physiology,
safety, social affiliation esteem and selfactualization.
3-Environments…. place where the people live.
This includes:
Physical characteristics such as goegraghy,climate
Biological and chemical characteristics: food, flora,
bacteria, water supply ….
Social characteristics i.e. economic , education religion ,
recreation ….
4-Service system.. Health, Education, Social
Welfare, Religions, Recreational, facilities,
Governmental, etc.
5- Boundaries: These boundaries serve to
regulate the exchange of energies between a
community and its external
An aggregate of people

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An aggregate is a community composed of people who share common
characteristics such as members of a community may share residence in
the same city, membership in the same religious organization, or similar
demographic characteristics such as age or ethnic background.
Communities may consist of overlapping aggregates; therefore some
community members may belong to multiple aggregates.
Aggregate usually share common economic pressures, life experiences,
interests, and concerns.
They lived through the many societal changes and may have similar
perspectives on current issues and trends
These shared interests translate into common goals and activities, which
are also defining attributes of a community.
Functions of community
Production, distribution, and consumption of
goods and services.
 Socialization of new members.
 Maintenance of social control.
 Adapting to ongoing and expected change
provisions of mutual aid.


PRODUCTION, DISTRIBUTION AND
CONSUMPTION:
The community produces, distributes, and
utilizes goods and services that are essential
for meeting the health and welfare needs of its
residents.

SOCIALIZATION
Is a process by which prevailing knowledge,
values, beliefs, behavior are transmitted to
community members to learn how to be
effective
SOCIAL PARTICIPATION:
Provide opportunity for members of the
community to achieve psychosocial wellness,
communication.
Social interaction with others supports to meet
self-fulfillment in the community.

SOCIAL CONTROL:
The community influences the behavior of its
members through norms and rules of social
control. A legal component is often enforced
through law agencies to safeguard and protect
the community.

MUTUAL SUPPORT:
Provision of aid to one another offered through
family, friends, religious groups, official health
and social departments within the community.

Three factors in particular affect community
dynamics:
(1) citizen participation in community health
programs,
 (2) the power and decision-making structure,
and
 (3) collaborative efforts of the community

Community Health
Community health is a state of equilibrium,
which derives from a balance between the
individual and his physical, psychological,
cultural and social environment.
Concept of Community Health
It has 3 common characteristics:
status, structure and process.
1) Status: such as:
Physical component of community health, it is measured by
traditional morbidity and mortality rates, vital statistics.
Emotional component can be measured by consumer satisfaction,
mental health indices.
Social component by crime rates, functional level.
2) Structure: Is the community health services and resources
utilization pattern.
3) Process: effective community functioning or problem solving is
well established.
The community as client refers to the concept
of a community-wide group of people as the
focus of nursing service.
Understanding the concept of the community
as client is a prerequisite for effective
service at every level of community nursing
practice.
Cont…..
First, the community directly influences the
health of individuals, families, groups,
subpopulations, and populations who are a
part of it
 Second, provision of most health services
occurs at the community level. Community
agencies help develop specific health programs
and disseminate health information to many
types of groups and populations

Dimensions of the community as client:Another perspective has 3 features:
 Location

Population

Social system
Location
a)- Boundary of community:Community boundaries serve as basis for
measuring incidence of wellness and illness and for
determining spread of diseases
b)- Location of health services:Use of health services depended on availability and
accessibility
C)-Geographic features:The environment can affect the health of a
community. As the possible problems and
resources, responds to an adaptive fashion.
Injury, death and destruction may be caused
by earthquakes, volcanoes
d)-Climate: The climate also has direct influence on the
health of a community

Extremes of heat and cold affect health and
fitness. The intense summer heat of a
location can create other health problems.
e)-Flora and fauna:Plants and animal populations in a
community are often determined by location.
Poisonous plants and animals can affect
community health. Plant and animals offer
resources as well as dangers .
Population
Size:
- the number of people influences number and
size of health care institutions .
Density: increased density may increase stress . high
and low density often affect the availability of health
services
Composition:
the population often determines
types of health needs
Rate of growth or decline
rapidly growing communities may place
excessive demands on health services .
marked decline in population may signal a
poorly functioning community
Cultural differences:
health needs vary among sub- cultural and ethnic
population's .Health practices and extent of
knowledge are affected by culture
Mobility:
mobility of the population affects continuity of care
.Mobility affects availability of services to highly Mobil
population
What is a Community Assessment (CA)
A collection and analysis of information on the
needs and characteristics of a community.
 Identifies issues and trends in the service area,
i.e. availability of disability services, other
programs that serve same population
 General data about the service area, i.e.
Geographic's, income, ethnicity

What is a Community Health Assessment?
Engages multiple organizations, agencies and
community members
 Informs action plans, decisions, funding
requests, and interventions
 Creates a positive environment for discussion
and change

Assessment of community health

The community health nurse is in a unique
position of being to see the community carry
out its functions and activities on a day-to-day
basis.
TYPES OF COMMUNITY NEEDS ASSESSMENT

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Familiarization or “Windshield Survey” (involves
studying data already available on a community, and
gathering a certain amount of firsthand data, to gain a
working knowledge of the community)
Problem-Oriented Assessment
Community Subsystem Assessment
Comprehensive Assessment
Community Assets Assessment (which focuses on the
strengths and capacities of a community rather than
its problems)
Purposes of community assessment:
It provides a means for looking at community
strengths, problems, and potential problems.
 It can identify aggregates at risk and gaps in
community resources.
(aggregates ) Is a collection of individuals who have in

common one or more personal or environmental
characteristics?
It provides a basis for community health
planning and providing services to the
community.
 To understand the community dynamics
because health action occurs in the
community.

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Health professionals need to understand the
traditions, beliefs, values, and attitudes so that
the health programs could be planned
according to the consumer satisfaction needs.
 It
helps to identify the factors that
facilitate or inhibit change in health
beliefs and practices of the community.
 Identify strengths and deficiencies in
relation to preventive health practices
REASONS FOR DOING COMMUNITY
ASSESSMENTS



Understand
context, resources
and needs
Locate hidden
strengths or
underutilized
resources
Determine which
resources
contribute to
comprehensive
strategies
REASONS FOR COMMUNITY ASSESSMENTS

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Design strategies that respond to real /
important conditions
Align actions with expressed needs
Empower communities
Document needs
Components of Community Health Assessment

5 Common Components
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demographic, social and economic community
profile
health risk profile
health/wellness (illness/death) outcomes profile
health promotion programs and health related
services profile
special studies
COLLECTING LOCAL INFORMATION
Target Community
Larger
Community
Community Assessment
Process
Form the Team
Design the Work
Gather and
Analyze Data
Write the (CA) Report with
Summary & Conclusions
Decisions
About
Priorities
And Goals
Grant
Application
Strategic
Plan
Eight Phases of Community Health Assessment
Phase 1: Establish a Community Assessment Team
Phase 2: Collect Community Data (primary/secondary)
Phase 3: Collect and Analyze Your Community’s Health Statistics (state and local
resources)
Phase 4: Combining Your County’s Health Statistics with Your Community Data
Phase 5: Solicit Community Input to Select Health Priorities
Phase 6: Create a CHA Document
Phase 7: Disseminate the Community Assessment Document to the Community
Phase 8: Develop the Community Health Action Plans
Steering Committee
HS
HS Core
Core Team
Team
Responsibilities
Collect data on community perceptions of issue areas through
key informant interviews, focus groups, community meetings,
surveys, etc.
Primary Data
Steering Committee
HS Core Team
Responsibilities
Gather, select and report existing data and opinions
Provide representation on each of the committees to be their data
expert – linking and summarizing existing data sets with them
Primary Data
Secondary
Data
Steering Committee
HS Core Team
Responsibilities
Develop a process to keep stakeholders informed
Primary Data
Secondary
Data
Communications
Steering Committee
HS Core Team
Mental
Health
Primary Data
Secondary
Data
Communications
Steering Committee
HS Core Team
Mental
Health
Primary Data
Physical
Health
Secondary
Data
Communications
Steering Committee
HS Core Team
Mental
Health
Primary Data
Physical
Health
Economic
Health
Secondary
Data
Communications
Steering Committee
HS Core Team
Mental
Health
Primary Data
Physical
Health
Economic
Health
Secondary
Data
Envrnmtl.
Health
Communications
Steering Committee
Safety
Mental
Health
Primary Data
HS Core Team
Physical
Health
Economic
Health
Secondary
Data
Envrnmtl.
Health
Communications
Steering Committee
Safety
Mental
Health
Primary Data
HS Core Team
Physical
Health
Economic
Health
Secondary
Data
Education
Envrnmtl.
Health
Communications
Steering Committee
Safety
Mental
Health
Primary Data
HS Core Team
Physical
Health
Economic
Health
Secondary
Data
Education
Envrnmtl.
Health
Communications
Steering Committee
HS Core Team
Committees
Responsibilities
Receive and review data
Develop themes and implications
Write a draft of their “chapter”
WHAT IS A HEALTHY COMMUNITY?
1. Collaborate effectively in identifying
community needs and problems
 2. Achieve a working consensus on goals and
priorities
 3. Agree on ways and means to implement the
agreed-upon goals
 4. Collaborate effectively to take the required
actions

COMMUNITY ASSESSMENT METHODS
Surveys
1. Planning Phase
a. Determine what information is needed and why.
b. Determine precise data to be collected.
c. Select population to be surveyed (eg, individuals, a
household, a city block).
d. Select survey method or instrument to be used (eg,
interviews, telephone calls, questionnaires).
e. Determine sampling size (eg, a percentage of the total
population in question).
2. Data Collection Phase
a. Identify and train data collectors (eg, interviewers).
b. Pretest and adjust instrument.
c. Supervise actual collection, including plans for
nonresponses or refusals.
3. Data Analysis and Presentation Phase
a. Organize data for tabulation and analysis.
b. Apply appropriate statistical methods.
c. Determine relationships and significance of
analysis.
d. Report results, including implications,
recommendations, and next steps needed;
provide feedback to the population surveyed
through a community forum (discussed later).
Descriptive Epidemiologic Studies

examines the amount and distribution of a
disease or health condition in a population
 by
person (Who is affected?),
 by place (Where does the condition occur?),
 and by time (When do the cases occur?)
Community Forums Meetings

is a qualitative assessment method designed
to obtain community opinions
Focus Groups
First, there is only a small group of articipants,
usually 5 to 15 people
 Usually the group meets for 1 to 3 hours, and
there may be a series of meetings.
 Major advantages of focus groups are their
efficiency and low cost, similar to the
community forum or town hall meeting format.

Steps of community assessment
1.
Data collection
Data interpretation:
3.
Community diagnosis:
.a- Planning
.b-Implementation
.c-Implementation mechanisms
.d Evaluation:
2.

1-Data collection
The systematic methods of data include :

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Gathering or compiling existing data;
Generating missing data;
Analysis & Interpretation of data;
Identification of health needs / problems and
capabilities.
Types of data collection
a. Data gathering :
 It is a process of obtaining readily available data.
These data usually describe the demography of
community i.e. : Age, sex, socioeconomic and racial distribution.
 Vital statistics, including morbidity and mortality data.
 Community institutions.
 Health manpower character
b. Data generation:
It is the process of developing data. That does not
already exist, through interaction with the community
members or groups. It includes information about
communities: i.e.
 Knowledge , beliefs and values
 Goals perceived needs, norms, and problem solving
process.
 Power and leadership and influence structures.
c. Composite data base:
A composite database is created by
combining the gathered and
generated data common characteristics of
people on the street, neighborhood, gathering
places, housing quality, geographic boundaries
etc.
The following are the five useful methods of collecting
data:
1.
Informant interviews, directed conversation with
selected members of a community
2.
3.
Participant observation
Windshield surveys (Familiarization )the nurse
driving a car or riding public transportation can observe many
dimensions of community's life and environment.
4.
5.
Secondary analysis of existing data
Surveys.
Sources of community data:
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primary and secondary sources
international sources
national sources
state sources
local sources
Primary and Secondary Sources
Information gathered by talking to people provides
primary data, because the data are obtained
directly from the community.
Community members, as formal leaders, informal
leaders, and community inhabitants, can frequently
offer the most accurate insights and comprehensive
information.
Secondary sources of data include people who
know the community well and the records such
people create in the performance of their jobs.


International sources :There are collected by several agencies
includes the world health organization and
six regional officer using the internet ,
international statistics of disease and
illness

National Sources
There are official and nonofficial sources of
national data that community health nurses
can access if needed. Official sources develop
documents based on data compiled by the
government.
 State
 The
sources :-
most significant state sources of
assessment data comes from the state
health department. This official agency
is responsible for collecting state vital
statistics and morbidity data.

Local sources:-
Some key sources are the visitors ,the city
chamber of commerce, City planner's office,
health department, hospitals, social services
agencies, county extension office. School
districts, university or college, Libraries,
Clergy, business and services organizations
2- Data interpretation:
Data interpretation seeks to attribute meaning to
the data. Data are analyzed and synthesized
and the following themes are identified: Community health needs / problems for action.
 Community health capabilities.
 Resources available to meet the needs.
Community Needs Assessment
Need, community resources, community needs
1. Felt need:
what the community says it needs
For example, community members may tell staff at a
community health center that they need more antenatal
care services within the area.
- Felt need is important because it reflects that which the
people themselves identify as their problems.
2. Expressed Need:
felt need turned into action, demonstrated by
such things as the number of names on a waiting list.
Needs Assessment
3. Normative Need:
needs determined by experts on the basis of professional
analysis.
For example, dietitians may determine the recommended daily
allowance of protein or fat.
4. Comparative Need:
determined by comparing the resources or services of one group
or area with those of another similar group or area.
For example, given area may be designated as needing more
public housing because it has less than do other areas of a
similar size and demography.
3- Community diagnosis
Community diagnosis generally refers to the
identification and quantification of health
problems in a community.
 It is based on collection and interpretation of
the relevant data about the dimensions of
the community and community health.

The statement of a community diagnosis must
consist of the following three components:
The problem faced by the recipient.
 The recipient of the care.
 The factors contributing to the problem.

While stating a diagnosis, the three components must be
stated as follows:
1. The risk of———————————————
2. Among ————————————————
3. Related to ———————————————
E.g. 1- Risk of infant malnutrition, among families in 'X'
 Community related to lack of breast feeding and weaning.
2- Risk of diarrhea in children under five, among families in
town dwellings, related to unhygienic environmental
condition / unsafe water supply.
Read p (360)

3.1- Planning
The planning for community health includes
the following steps:
1- Analyze the community diagnosis in terms
of the importance, magnitude and Intensity
of risk involved.
2- Establish priorities among them.
3- Establish goal & activities.
4- Rational allocation of limited resources.
(review figure 15-2 p 561)
In planning phase nurse must :
1- Determine what and why information is
needed
2- Determine precise data to be collected
3- Select population to be surveyed
4- Determine sampling size
2-Implementation

The forth phase of the nursing process /
community organization is a shared activity as
part of the activity may be delegated to others.
Factors influencing implementation
1- Nurse's chosen role: A facilitator / expert
role in helping community to select and
perform appropriate tasks to achieve
objectives.
2- Nurse could act also as a change agent role,
change partner role in which the nurse
remain as teacher of problem solving skills
and an adviser.

3- Community's readiness to participate in the
problem resolution.
4- Characteristics of social change process.
3-Implementation mechanisms
The nurse must identify and appropriately use
these mechanisms:
1 - Small interacting group (formal &informal).
2- Lay advisers: the individuals who are
influential in the community e.g. community
leaders, religious leaders, welfare group etc.
3- Mass media: like newspapers, television,
radio, health, magazines etc.
( read p 368)
4- Develops specific activities for promotion and
maintenance of health which may include:
Safe disposal of wastes.
Water purification.
Development of individual, family and
community capabilities to cope with the
responsibility for their own health.
4 Evaluation:
1.
2.
3.
4.
Appraisal of the effects of the organized
program.
Documenting the progress.
Compares achievements against a
performance standard.
Preparing f or needed modification.
With evaluation the entire process I open to
re-negotiation to achieve"
community health".
Epidemiologic investigations focus on:
Infectious disease
 Non-infectious chronic conditions
 Acute events
 Emotional/Mental Health conditions
 Normal characteristics of populations

References
Stanhope, M. & Lancaster, J. (2004). Community
& Public Health Nursing, 6th Ed. Mosby. St.
Louis, MO, USA. Chapters 15 & 11